Impact of health literacy-directed colonoscopy bowel preparation instruction sheet

Terry C. Davis, Jill Hancock, James Morris, Perry Branim, Abhishek Seth, Alfred Rademaker, Connie L. Arnold*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objectives: To improve patient colonoscopy bowel preparation with a newly developed simplified instruction sheet in a safety-net hospital system. Methods: Bowel preparation quality was compared in a retrospective chart review of 543 patients, 287 of whom received standard instructions (9th grade reading level) between November 2015 and February 2016, and 256 of whom received simplified instructions (6th grade level) between March and May 2016. Instructions were mailed to all patients. The primary outcome was bowel preparation quality recorded by the endoscopist as optimal or suboptimal preparation. Results: 543 medical records were reviewed and results indicated a significant association between the instructions used and preparation quality with patients receiving simplified instructions being significantly more prepared (69.1% vs 65.5%) and having a lower cancellation rate (4.7% vs 10.5%), p = .042. Conclusions: A no-cost simplified colonoscopy instruction sheet improved bowel preparation among patients in an academic safety-net health system.

Original languageEnglish (US)
Pages (from-to)301-308
Number of pages8
JournalAmerican Journal of Health Behavior
Issue number3
StatePublished - May 2017


  • Colonoscopy bowel preparation
  • Health literacy
  • Simplified instructions

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health
  • Social Psychology


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